Evaluation of cue reactivity in the natural environment of smokers using ecological momentary assessment

The cue reactivity (CR) paradigm has been used extensively to assess smokers' craving responses to smoking-related stimuli. To date, nearly all CR research has been conducted in laboratory settings; there has been no experimental research of the impact of smoking cues on smokers' craving in their natural environment. The present research combined CR procedures with ecological momentary assessment (CREMA); the latter has been used successfully to monitor a variety of behaviors in real time using handheld personal digital assistants (PDAs). Participants were 43 daily, heavy smokers ages 18 and older. PDAs were sent home with participants over an 8-day CREMA period. PDAs were used to record each cigarette smoked and to administer daily CR trials. CR stimuli consisted of photographs and imagery scripts that were either smoking related or neutral. CR trials were also administered in the laboratory, by means of PDAs, at the beginning and end of the CREMA period. Results from CREMA trials indicated that smoking-related cues significantly increased craving, compared with neutral cues for both photographs and imagery scripts. This pattern was also observed in the laboratory-based trials. Findings indicate that CREMA is well suited for the investigation of cue-elicited craving under real-world conditions.